Factors associated with coverage of praziquantel for schistosomiasis control in the communitydirect intervention (CDI) approach in Mali (West Africa)

Background:Despite the progress made in the control of Neglected Tropical Diseases(NTD),schistosome and soil-transmitted helminth infections are far from being effectively managed in many parts of the world.Chemotherapy,the key element of all control strategies,is faced with some difficulties in terms of access to treatment.Our study aims to describe the factors involved in the success or failure of the community-directed intervention(CDI)approach through control programmes,which aims to achieve consistent high coverage at affordable and sustainable costs in endemic areas.Methods:The CDI approach was carried out from December 2007 to October 2008 in ten villages of the district of Diéma,Mali.At inclusion,each child part of the study’s sample was interviewed and submitted for a physical examination.The study focused on:data collection,treatment of the eligible population,evaluation of the treatment coverage,performance of community drug distributors(CDDs),and the involvement and perception of populations.Results:A total of 8,022 eligible people were studied with a mean coverage rate of 76.7%.Using multiple regression,it was determined that receiving praziquantel as treatment was associated with five factors:belonging to the Fulani or Moorish ethnic minority versus the Bambara/Soninke,use of the central versus the house-to-house drug distribution mode,the ratio of the population to the number of CDDs,the lack of supervision and belonging to the age group of 15 years or above(p<0.05).As well as that,it was found that the presence of parallel community-based programmes(HIV,tuberculosis)that provide financial incentives for community members discouraged many CDDs(who in most cases are volunteers)to participate in the CDI approach due to a lack of incentives.Conclusions:The findings indicate that the success of the CDI approach depends on,amongst other things,the personal characteristics of the respondents,as well as on community factors.

Ultrasound aspects and risk factors associated with urogenital schistosomiasis among primary school children in Mali

Background Urogenital schistosomiasis is endemic in Mali and is a major cause of serious morbidity in large parts of the world.This disease is responsible for many socio-economic and public health issues.The aim of this study was to investigate the impact of the disease on morbidity and to describe demographic and socioeconomic factors in relation to the status of children with urogenital schistosomiasis in Mali.Methods We conducted a cross-sectional study in November 2021 of 971 children aged 6 to 14 years selected at random from six schools in three districts in the Kayes Region of Mali.Demographic and socioeconomic data were collected on survey forms.Clinical data were collected following a medical consultation.Hematuria was systematically searched for through the use of strips.The search for Schistosoma haematobium eggs in urine was done via the filtration method.The urinary tract was examined by ultrasound.Associations between each of these variables and disease infection were tested using multivariate logistic regression.Results The overall prevalence of urinary schistosomiasis detected was 50.2%.The average intensity of infection was 36 eggs/10 ml of urine.The associated risk factors for urogenital schistosomiasis showed that children who bathed,used the river/pond as a domestic water source,and who habitually urinated in the river/pond were more affected(P<0.05).Children with farming parents were most affected(P=0.032).The collection of clinical signs revealed that boys had more pollakiuria(58.6%)and dysuria(46.4%)than girls.Ultrasound data showed that focal lesion rates were recorded in all villages with the lowest rate in Diakalel(56.1%).Ultrasound and parasitological findings showed that irregularity and thickening were strongly associated with urinary schistosomiasis(P<0.0001).Conclusions Schistosoma haematobium infection was still endemic in the study site despite more than a decade of mass treatment with praziquantel.However,the high percentage of symptoms associated with high intensity reinforces the idea that further studies in terms of schistosomiasis-related morbidity are still needed.

Urban schistosomiasis and associated determinant factors among school children in Bamako, Mali, West Africa

Background:Schistosomiasis is classically described as a rural disease that occurs in areas with poor sanitary conditions.However,over recent decades,there has been an expansion of schistosomiasis foci towards urban areas faced with a rapid and disordered urbanization.In Bamako,Mali,the impact of environmental change on vector-borne diseases such as schistosomiasis is not well known.This study sought to identify the presence of schistosomiasis transmission hotspots in Bamako.Using this perspective,we aimed to describe the risk factors of the endemization and maintenance of schistosomiasis.Materials and methods:A cross-sectional study was carried out in the six municipalities(communes)in Bamako.Environmental information was obtained from earth observation satellites in order to maximize ecological contrasts.Twenty-nine blocks of 200 m x 200 m were identified.We selected a school inside or nearest to each block for urine and stool samples examination.The study cohort was school children aged between eight and 15 years.The Kato-Katz technique and filtration were used for Schistosoma mansoni and S.haematobium ova research in stools and urine,respectively.The schools and snail breeding sites were georeferenced.Four malacological surveys were conducted between October 2011 and February 2012.Bivariate analysis was used to identify independent predictors of being infected with schistosomiasis.Results:The prevalence rate of S.haematobium was 14.7%(n=1,761)and that of S.mansoni 1.5%(n=1,491).Overall,the urinary form was endemic in 76.6%of schools.The infection significantly varied between the municipalities(p<0.001).It was also more prevalent on the left side of the Niger River than the right side(17.4%vs.9.5%respectively;p<0.001).The vicinity to snail breeding sites(OR=3.677;95%IC[2.765–4.889];p<10-3)and parents’occupations(OR=7.647;95%IC[2.406–24.305];p<0.001)were the most important risk factors associated with S.haematobium infection exposure.Biomphalaria pfeifferi,Bulinus truncatus,and B.globosus were the intermediate hosts captured.The schistosome natural infection rates(SNIRs),which were low or nil in October and November,rose to 2.8%in January and 8.3%in February for B.pfeifferi and B.truncatus,respectively.Conclusion:Our findings show that there is a high transmission risk for schistosomiasis in Bamako.Appropriate integrated control measures need to be introduced to control the transmission of this disease in the study area.